1. PROGRESS ON IMPLEMENTATION OF THE BABY FRIENDLY HEALTH FACILITIES INITIATIVE IN GHANA BY MS. VERONICA M. GOMEZ TRAINING COORDINATOR, GINAN

2. CONTENT AIM OBJECTIVES METHODOLOGY INTRODUCTION ADOPTION AND LAUNCHING OF BABY FRIENDLY INITIATIVE INTERVENTIONS RESULTS AND DISCUSSIONS CHALLENGES, WAY FORWARD

3. AIM To assess and document the progress of the Baby Friendly Health Facility Initiative (BFHI) in Ghana. OBJECTIVES To document mode of implementation of the BFHI in Ghana To assess impact of implementation of BFHI on breastfeeding indicators in Ghana

4. METHODOLOGY Desk review of annual reports and documents. Discussions with Policy makers, BFHI Authority members, Project Managers, Coordinators, Health Staff and mothers. Analysis of data from Demographic and Health Survey Reports from 1988 to 2014

5. INTRODUCTION Baseline survey on breastfeeding practices support and status commissioned by UNICEF in 1992 Poor findings including - 2% exclusive breastfeeding rate - Tradition of giving water to welcome baby - Discarding of colostrum - Giving of prelacteal feeds routinely - No rooming - in or bedding - in

6. INTRODUCTION CONT’D - High Feeding bottle use (53%) - Early introduction of complementary foods - Promotion of breastmilk subst. in health facilities - Poor information in preservice curricula of health training schools

7. ADOPTION AND LAUNCHING OF BFHI Dissemination of findings to health and other professionals interested in Infant and Young Child feeding BFHI Authority launched by Minister of Health 1993 BFHI launched by Minister of Health in 1993

8. INTERVENTIONS Inauguration of BFHI Authority by Minister of Health to oversee implementation of BFHI. Development of a National Breastfeeding Policy and Project document. Training of Master Trainers for BFHI for all Regions and Teaching Hospitals (18hr & 20hr courses). Capacity building of Health Staff in Lactation Management and Counselling Skills.

9. INTERVENTIONS CONT’D Training and formation of Mother Support Groups. Assessment and Designation of Health Facilities as Baby Friendly. Monitoring of Baby Friendly Health Facilities. Integration of Breastfeeding issues into other programs (Safe mother hood, IMNCI, HIV/AIDS, IYCF etc.)

10. IINTERVENTIONS CONT’D Ratified the International Code as law in 2000. Advocacy (WBW media, media training and education). Trainings on BCC and development of IEC materials for staff and community members.

11. RESULTS AND DISCUSSIONS 507 Health Facilities are Baby Friendly ie. 35% of all facilities providing maternity services All public Health Facilities practice bedding-in. The Code was ratified in the year 2000. Preservice curricula of medical, nursing, paramedical schools have been updated and reviewed.

17. CHALLENGES High attrition rate of Regional trainers, trained BFHI staff and assessors (transfers, retirement) Rampant reshuffling of trained personnel from maternity wards Reduced funding for BFHI activities (Donor and Government) since 2009. Complacency among Donors, GHS and Health Staff when we got to 63% exclusive breastfeeding rate in 2008 (DHS) and therefore reducing funding and activities towards BFHI implementation Standards of BFHI facilities are not maintained due to inadequate monitoring and supervision

18. CHALLENGES CONT’D Standards of BFHI facilities are not maintained due to inadequate monitoring and supervision Inadequate education and provision made for working mothers. The Private sector has been left out in BFHI implementation Aggressive promotional activities by Infant Food Manufacturers especially Nestle in recent years. Non sustainability of MSG’s

19. WAY FORWARD Relaunching of the BFHI. Reassessment of BFHI Health Facilities. Decentralization of BFHI to Regional and District levels.